A Successful Regional Health Department in Colorado Richard L. Vogt, M.D. Executive Director CCI Conference, June 10, 20

1. A Successful Regional Health Department in Colorado Richard L. Vogt, M.D. Executive Director CCI Conference, June 10, 2009

2. Composition • Tri-County Health Department (TCHD) serves Adams, Arapahoe and Douglas Counties • We serve 1¼ million residents, ¼ of Colorado’s population • Our Board of Health has three appointed representatives from each county, for a total of nine members

3. History • TCHD was formed in 1948 to include Adams, Arapahoe and Jefferson Counties

4. History • In 1958, Jefferson County formed its own Health Department, so TCHD served only two counties until 1966 • In 1966, Douglas County decided to join TCHD after they received mutual aid in response to the South Platte River floods

5. Approach as a Regional Health Department • Delicate balance functioning as one health department serving the needs of three diverse counties • TCHD needs to keep consistent approaches for all of our three counties • However, each county has special needs and interests that also need to be addressed

6. Regional Health Department • Provide core services to all three of our counties • Provide some individualized services for each of our counties

7. Core Services Offered to Each County • Nursing • Adult and child immunizations • Family planning • Women’s cancer screenings • Maternal child health programs • Access to care programs • HIV/AIDS, sexually-transmitted disease and TB outreach programs • Chronic disease prevention

8. Core Services • Environmental Health • Restaurant inspection program • Child care inspection program • Pool/spa inspection program • Onsite-wastewater program • Hazardous chemicals in schools • Land use reviews • Vector control

9. Core Services • Nutrition • WIC program • Community nutrition • Early childhood obesity and prevention • Dietetic internship • Breast-feeding support program

10. Core Services • Epidemiology, Planning and Communication • Infectious disease investigation • Outbreak control • Public information • Tobacco prevention • Statewide older adult fall prevention program • Health planning • Geographic Information Systems (GIS)

11. Core Services • Emergency Preparedness • Developed emergency response plans in coordination with external and internal partners • Coordinated agency responses to public health emergencies • Coordinated the strategic national stockpile and mass prophylaxis • Developed agency continuing operation plans (COOP)

12. Core Support Services • Administration • Purchasing • Payroll • Human resources • Information technology • Facility management

13. Individual County Interests and Programs

14. Adams County • Major interest in protective measures with oversight of landfills and the Rocky Mountain Arsenal cleanup project • Developed an innovative mutual agreement with Adams County Human Services to provide selected nursing services for human service clients using Temporary Assistance for Needy Families (TANF) funds • Household hazardous waste disposal

15. Arapahoe County • Largest populated county in our jurisdiction • We have special funding to help provide dental services for Arapahoe County senior citizens • Developing a similar program with social services again using TANF funds • Arapahoe County has shown a special interest in outbreaks of illness that require planning • West Nile Virus • H1N1 influenza infections

16. Douglas County • Has a special interest in water • Quantity • Quality • TCHD conducted a special study of the quality of well water in homes that have septic systems, finding little contamination in households with submitted samples • Household hazardous waste disposal

17. Three-County Agreement • In 1988, all three sets of County Commissioners entered into an agreement to provide the same level of county per capita funding • The advantage is that there is a common contribution for all of the three counties • A disadvantage is that we are funded at a level that the most financially challenged county can afford each year • We also have individual contracts for county-specific activities

18. Benefits of Regional Health Department • Provide more uniform services across counties • Provide enough depth to shift resources depending upon the public health need • Can provide a significant nursing workforce for public health activities in the area • Able to undertake large campaigns • In 1992, administered IG to 15,000 residents • In 1993, coordinated activities for the Pope’s visit • In 2009, administered 1,300 doses of IG and hepatitis A vaccine

19. Benefits • Receive financial support from three counties which enables us to have professionals and programs that would otherwise be unavailable • We have economies of scale with one office of administrative services for three counties

20. Challenges • A presence in each of our three counties • Staff liaison in an office located in each county • Attendance at each of the many county functions • Volunteer appreciation receptions • Ground-breaking and dedication ceremonies • Presentations of our proposed budget to each county

21. Challenges • Campaign with Commissioners over the years with the theme that “TCHD is your local health department” • Lack of recognition as a “department” similar to those housed within the county structure • Lack of awareness by county residents that TCHD is their county health department

22. Challenges • Some difficulty in managing 11 offices in our jurisdiction • Four full service offices • Two partial service offices • Four WIC offices • One administrative office • Currently have an “office director” for each office

23. Challenges • Arrange for courier services between offices • Negotiate multiple leases for properties not supported by counties • Strive to be “equal and fair” to employees in 11 different offices • Strive to provide uniform services between the different offices

24. Space Challenge • At present, each county provides at least one office for TCHD free-of-charge • However, one county has provided all of our office space at no charge • TCHD contracted with a consulting firm to evaluate the current county space support • The results will be presented to our three sets of County Commissioners

25. Douglas County Study • In 2003, Douglas County formed a committee to review the possibility of forming their own LHD • At that time, Colorado Statutes allowed this to happen, giving 12 months notice to the LHD • TCHD convinced Douglas County of the worth of our agency to provide services to residents • In the end, Douglas County decided to stay with TCHD because of “economies of scale” and demonstration of vision and strong leadership

26. Activities • Undertaken a campaign to be included in all written county reports that list county departments • Attempted to attend all county functions recognizing county departments • Attempted to send a TCHD staff representative for regular county management meetings

27. Summary • There are many advantages to establishing a regional health department • However, the process is not without challenges • At present, each of our three counties feel that we are providing cost-effective, high- quality public health services to our residents and are attentive to individual county needs

28. Thank you!